November 24, 2004

Record-Eagle/Douglas Tesner
Cindy Prince, above, and her husband Don, missionaries with the national disability ministry Joni & Friends, collected wheelchairs, crutches, walkers and other used medical equipment that will be sent to Honduras.

Drug Dilemma

Options for recycling unused medications limited

By
Record-Eagle staff writer

When her husband passed away in June, Dol Giles was left with more than a dozen containers of expensive medicine, most two-thirds full.
"It seemed a shame to toss it all out," said Giles, of Traverse City. "We donate old eyeglasses and old hearing aids to be used again."
With the rising cost of prescription drugs, more and more Americans are seeking ways to recycle medicine and medical supplies left over after a death or change in treatment. Current law ensures that most of it ends up in landfills.
Generally it is illegal to recycle prescription drugs in the U.S. But some states have established drug repository programs or are studying the feasibility of donating unused prescription drugs from nursing homes to charities to eliminate prescription medication waste.
In January 2003, Ohio Gov. Bob Taft signed legislation making Ohio the first state in the nation to create such a repository program. Instead of going unused, unexpired and unopened medications can end up in the hands of needy Ohioans. The drugs can be donated by any person, pharmaceutical manufacturer or health care facility to a pharmacy, hospital or nonprofit clinic that makes the voluntary decision to participate in the state program. Recipients only have to pay a handling fee.
The bill was prompted by an Ohio man who lost his wife to cancer, then became frustrated when he had to throw away thousands of dollars worth of her prescription medication. The drugs were unused and properly sealed, but no process was in place to allow them to be used safely by other cancer patients.
A similar program in Michigan has been discussed at the staff level but no further, said T.J. Bucholz, director of communications for the Michigan Department of Community Health.
"We just don't think it's feasible," Bucholz said. "Given the budget that we have, I don't think we have the resources to create that kind of infrastructure."
Even if such a program could be implemented, it would come with a huge set of problems, experts say.
"Obviously it would be wonderful if there was a group or a drop-off point for those meds that we could then turn around and dispense to uninsured patients," said Cathy Manville, a pharmacy technician with the Community Pharmacy Program in Traverse City, which provides free medications to low-income older adults without prescription insurance coverage. "The logistics of sorting it and identifying and reissuing it is ugly."
And that's not the only concern, said Ned Milne, manager of retail pharmacies for Munson Medical Center. Improper storage conditions could also render recycled drugs impotent or unsafe.
"Under Michigan state law, once a product is out of our control, we can not redispense it because we can no longer control the storage conditions," Milne said. "In a nursing care facility, if (a drug was moved from floor to floor) it never left the institution. But at retail, it could have laid up on somebody's dashboard in the car for four days in the summer before it was dropped off. Or it may be coming back to us from someone's home who has tuberculosis. Would you want your 86-year-old mother taking a drug that was in a home with an infectious disease?"
Liability could also be an issue, which may be one reason why so few Ohio pharmacies have expressed an interest in participating in the state's voluntary drug repository program so far, said Kelly Vyzral, director of government affairs for the Ohio Pharmacists Association.
"There's just a lot of legal repercussions and liability issues with people turning drugs in: who's responsible, who's liable, how's it stored?" Vyzral said.
Despite all the risks, some grassroots organizations have mobilized to collect unused medications which are donated to needy people in developing countries.
One such organization is Aid for AIDS, A New York-based non-profit group committed to improving the quality of life of people with HIV/AIDS in Latin America, the Caribbean and Africa. In 2002, AFA sent medications worth more than US $5 overseas to people with HIV who would otherwise not have access to medication, said Executive Assistant Brittany Nuttall.
While the U.S. Food and Drug Administration forbids the delivery or receipt of drugs from any source other than the manufacturer, processor, packer or distributor, Nuttall said a "legal loophole" allows the group to carry out its work.
"It's illegal to redistribute drugs in the U.S.; however it is completely within the law to have medication within the U.S. be redirected to other countries because it's considered humanitarian aid," she said.
AFA collects donated medication from various sources across the United States and Canada, including from people with HIV who change prescriptions, stop taking a certain medication or die. It does not accept unsealed bottles of liquid medicine, and each tablet and capsule is hand-checked to ensure it has the pharmaceutical imprint before sent overseas, Nuttall said.
Although well-meant, donated drugs can sometimes cause as much harm as good, according to the World Health Organization. Some drugs may be unneeded, inappropriate or unusable because of being improperly stored, labeled or transported. Others may be received already expired, in too small a quantity to treat effectively or identified only by brand names which are unfamiliar to local health professionals.
Between 1992 and 1996 in Bosnia and Herzegovina, an estimated 17,000 metric tons of inappropriate donations were received with an estimated disposal cost of US $34 million, according to WHO.
Milne encourages people who have paid for medication they no longer need to contact their health care provider to see if he or she has a financially challenged patient who can use it.
Otherwise, medication should be disposed of in the trash or at a hazardous household waste collection site - not flushed down the toilet, according to the Michigan Department of Environmental Quality.
"It used to be considered stuff you can eat you can flush down the toilet," said Scott Blair, plant manager for Operations Management International, the private company that operates Traverse City's wastewater treatment plant. "But there's been a fairly recent flurry of concern about whether those things can have a harmful impact."
In fact, antibiotics, hormones, painkillers, antidepressants and other medications are now finding their way in the nation's waterways and experts worry that exposure to even small amounts may cause ecological or other harm.
"Erring on the side of safety, the advice to individuals would be to throw it away rather than flush it," Blair said.